Intra-breath arterial oxygen oscillations detected by a fast oxygen sensor in an animal model of acute respiratory distress syndrome.

BACKGROUND: There is considerable interest in oxygen partial pressure (Po2) monitoring in physiology, and in tracking Po2 changes dynamically when it varies rapidly. For example, arterial Po2 ([Formula: see text]) can vary within the respiratory cycle in cyclical atelectasis (CA), where [Formula: see text] is thought to increase and decrease during inspiration and expiration, respectively. A sensor that detects these [Formula: see text] oscillations could become a useful diagnostic tool of CA during acute respiratory distress syndrome (ARDS). METHODS: We developed a fibreoptic Po2 sensor (<200 µm diameter), suitable for human use, that has a fast response time, and can measure Po2 continuously in blood. By altering the inspired fraction of oxygen ([Formula: see text]) from 21 to 100% in four healthy animal models, we determined the linearity of the sensor's signal over a wide range of [Formula: see text] values in vivo. We also hypothesized that the sensor could measure rapid intra-breath [Formula: see text] oscillations in a large animal model of ARDS. RESULTS: In the healthy animal models, [Formula: see text] responses to changes in [Formula: see text] were in agreement with conventional intermittent blood-gas analysis (n=39) for a wide range of [Formula: see text] values, from 10 to 73 kPa. In the animal lavage model of CA, the sensor detected [Formula: see text] oscillations, also at clinically relevant [Formula: see text] levels close to 9 kPa. CONCLUSIONS: We conclude that these fibreoptic [Formula: see text] sensors have the potential to become a diagnostic tool for CA in ARDS.

Within-breath arterial PO2 oscillations in an experimental model of acute respiratory distress syndrome.

Tidal ventilation causes within-breath oscillations in alveolar oxygen concentration, with an amplitude which depends on the prevailing ventilator settings. These alveolar oxygen oscillations are transmitted to arterial oxygen tension, PaO2, but with an amplitude which now depends upon the magnitude of venous admixture or true shunt, QS/QT. We investigated the effect of positive end-expiratory pressure (PEEP) on the amplitude of the PaO2 oscillations, using an atelectasis model of shunt. Blood PaO2 was measured on-line with an intravascular PaO2 sensor, which had a 2-4 s response time (10-90%). The magnitude of the time-varying PaO2 oscillation was titrated against applied PEEP while tidal volume, respiratory rate and inspired oxygen concentration were kept constant. The amplitude of the PaO2 oscillation, delta PaO2, and the mean PaO2 value varied with the level of PEEP applied. At zero PEEP, both the amplitude and the mean were at their lowest values. As PEEP was increased to 1.5 kPa, both delta PaO2 and the mean PaO2 increased to a maximum. Thereafter, the mean PaO2 increased but delta PaO2 decreased. Clear oscillations of PaO2 were seen even at the lowest mean PaO2, 9.5 kPa. Conventional respiratory models of venous admixture predict that these PaO2 oscillations will be reduced by the steep part of the oxyhaemoglobin dissociation curve if a constant pulmonary shunt exists throughout the whole respiratory cycle. The facts that the PaO2 oscillations occurred at all mean PaO2 values and that their amplitude increased with increasing PEEP suggest that QS/QT, in the atelectasis model, varies between end-expiration and end-inspiration, having a much lower value during inspiration than during expiration.

Commotio cordis: a deadly consequence of chest trauma.

Commotio cordis is arrhythmia or sudden death from low-impact, blunt trauma to the chest without apparent heart injury. Ventricular fibrillation is the most common associated arrhythmia, and heart block, bundle branch block, and ST-segment elevation are also seen. Commotio cordis occurs most commonly in baseball but has also been reported in hockey, softball, and several other sports. Approximately two to four cases are reported each year, but the true incidence is uncertain. Survival is low, even when resuscitation is performed. Preventive measures include education of participants and coaches, chest protection, and softer baseballs. Other considerations include having external automatic defibrillators and trained personnel at youth sporting events.

Measurement of tidal flow using a transit-time ultrasonic breath analyser.

The ability of the Transit-time Ultrasonic Breath Analyser (TUBA, GHG Medical Electronics GMBH, Zürich, Switzerland) to measure peak flow and tidal volume in the laboratory was tested using a variety of flow and pressure conditions, chosen to simulate the respiratory patterns of patients receiving mechanical ventilatory support. A stable zero baseline was achieved by acoustic damping of the TUBA flow sensor head. A piston pump was used to generate sinusoidal flow pattern, with a peak flow range from 0.1 to 1.51.s-1. The calculated peak flow matched the peak flow measured by the TUBA. The TUBA accurately measured tidal volumes (+/- 10%) delivered using three different flow patterns over a range of volumes from 0.25 to 11. We conclude, that once modified, the TUBA can provide an accurate measurement of peak flow and tidal volume over a range of values likely to be encountered during mechanical ventilation of the lungs.

An evaluation of the Brüel and Kjaer monitor 1304.

A laboratory evaluation was performed on the Brüel and Kjaer multigas monitor 1304, incorporating a pulse oximeter. The instrument was tested for accuracy, stability, response and delay times, frequency response and the effects of water vapour, alcohol, cyclopropane and sevoflurane. The instrument's performance was found to be within or very close to the manufacturer's specifications for accuracy, stability and response and delay times. It was unaffected by water vapour and alcohol and the effect of cyclopropane on the vapour channel was lower than has been reported for other analysers. The response to sevoflurane was of the same order as that of the other vapours. A 90% response to square wave changes of gas composition was maintained up to 60 breaths.min-1 for CO2, O2, and N2O and up to 40 breaths.min-1 for the vapours when the nafion sampling tube was used.

Evaluation of a multigas anaesthetic monitor: the Datex Capnomac.

A laboratory investigation was carried out to evaluate the performance of the Datex Capnomac multigas anaesthetic agent analyser, with particular emphasis on accuracy, response and delay times, zero and gain stability and interference from water vapour. The analysis of anaesthetic vapours was less accurate than the analysis of CO2, O2 and N2O, but acceptable for clinical use. The response to square wave changes in gas composition was accurate at frequencies up to 60 per minute for CO2 and 30 per minute for O2, but with N2O and the anaesthetic vapours there was a decrease in accuracy at frequencies above 20 breaths/minute. The instrument appeared to be unaffected by water vapour.